Part 4: Sun, sand and surrogates

CANCUN, MEXICO – Miriam the surrogate is wearing four estrogen patches across her lower abdomen and a Santa Muerte religious idol on a delicate chain around her neck.

Before she moved to the resort town of Cancun to live in a small house teeming with eight other Mexican women preparing to carry babies for international couples, Galicia was a police officer in Toluca. She and her fellow officers believed Santa Muerte - the Saint of Death - would protect them.

So Galicia, 35, still wears the Saint of Death as she works in her new job as a vessel of life, preparing her body to carry an embryo belonging to an HIV-positive gay couple from the United States.

“Policing is very dangerous and my children need me. I would rather do this,” the single mother of three says in Spanish, rolling the pendant on her necklace between her fingers as she sits on one of four beds in a second-floor bedroom.

Elsewhere in the house, two other women are pregnant with babies intended for Canadian gay couples and a third is waiting for an embryo transfer from a Canadian gay couple with HIV.

Canadians have been flocking for years to Cancun, a beach paradise lined with luxury resorts, expensive shops and gourmet restaurants. But now a number of gay Canadians desperate to have babies are going there to visit a little-known fertility clinic, and to seek the services of Mexican surrogates. The women live in a boarding house owned by a medical tourism company that markets to gay men around the world.

The company, Planet Hospital, estimates that about 15 per cent of their gay surrogacy clients are Canadian.

But international surrogacy is a process fraught with ethical and medical dilemmas. Not the least of which is the possibility that the women who bear these children are being exploited.

“Absolutely, we are all concerned about exploitation. And that was the whole point behind the legislation in Canada – not to have it,” says Dr. Mathias Gysler, the president of the Canadian Fertility and Andrology Society.

“When you take somebody from a lower level of society in India, for instance, and are giving them maybe $8,000 or $10,000, you’re not telling me that this isn’t financial exploitation.”

Yet Gysler says he understands why so many people, both heterosexual and gay, seek these services outside Canada.

“They’re not going abroad because they want to. They’re going abroad because the services are not available here.”

***

In Canada, surrogacy is not illegal, but it can be extremely difficult – financially, logistically and legally. For gay men who want to have children who are biologically related to them, surrogacy is the only option.

Paying a surrogate a fee is banned under the Assisted Human Reproduction Act. Would-be parents can repay a surrogate for out-of-pocket costs directly related to her pregnancy, but the federal government hasn’t outlined what exactly those expenses entail.

“That leaves us in a grey zone,” says Sally Rhoads-Heinrich, founder and administrator of Surrogacy in Canada Online.

Some experts say those surrogate expenses range between $18 and $25,000. But the threat of a $500,000 fine and/or up to 10 years in prison for paying a surrogate a fee leaves people pretty nervous about the whole process, Rhoads-Heinrich says.

As a result of surrogacy having to be altruistic, there aren’t a lot of Canadian women willing to have a baby for someone else. Experts estimate that there is one surrogate available for every 20 people who need one to start their family.

And they’re difficult to find. A few surrogacy services and co-ordinators such as Rhoads-Heinrich exist in Canada, but they’re rare since it’s also illegal to accept payment for arranging surrogacy services.

But just because Canadian surrogacy isn’t commercialized doesn’t mean it’s not expensive. Between legal fees, medications, surrogacy expenses and the cost of In vitro fertilization (IVF) and retrieving a donor egg, some experts say domestic surrogacy can cost between $45,000 and $60,000. Although experts say this is difficult to pin down and can range in either direction.

On top of the legal, logistical and financial challenges, getting the information necessary to move forward is another challenge for gay men. Most heterosexual couples or single women seeking surrogacy are already attuned with assisted reproduction, many spending grueling and heartbreaking years consulting fertility specialists or trying IVF before they decide to take this step.

For gay men, turning to surrogacy is the starting point.

Sam, a 24-year-old computer programmer from Edmonton, says he always knew he wanted children. When he and his husband were married last year, they started saving their money and doing research.

“We were looking at different options but we didn’t really know where to go, who to ask, what to do. For us it was a challenge to track the information down,” says Sam, who declined to give his last name or the name of his husband.

He eventually found the Planet Hospital website and filled out an information form. He spoke with the CEO and the VP, both of whom sold him on taking the next step.

In late July, Sam travelled to Cancun to make a semen deposit at Planet Hospital’s partner clinic. If all goes well, for about $42,000 U.S., Sam and his husband could be parents within a year.

“It’s not a hassle. It’s doable. And it’s cheaper,” he says.

***

Planet Hospital is a California-based medical tourism company, founded by Calgary-raised businessman Rudy Rupak, and is involved in sectors of private, international medical programs all over the world, including surrogacy.

Within Planet Hospital’s surrogacy program is a specialty called “Surrogaycy,” which markets directly to gay men. Currently, those men have the choice of starting their families in Thailand or Mexico.

In Cancun, clients come to Fertility Center Cancun, a Planet Hospital partner clinic in the downtown core. Although the company just recently purchased its own Cancun fertility clinic and has plans to send future clients there.

With international surrogacy, Rupak is at the helm of a largely uncharted, complex field mired in ethical and legal dilemmas. He’s had to learn as he goes, and it hasn’t always gone well.

“It’s a never-ending battle,” Rupak, 42, says.

A quick Internet search of Rupak’s name brings up both praise and thanks for Planet Hospital and message boards stacked with scathing complaints of their surrogacy practices.

In the last two years, Rupak says he has had an Indian fertility clinic “scam” his clients, leaving them out of pocket and childless (he says he has paid all those clients back), has had his own employees turn against him and drag Planet Hospital’s name “through the mud,” and he briefly dabbled in selling medical tourism insurance – an experiment that turned out to be “a spectacular failure” and cost him a “huge” settlement fine, he says.

Disheartened, he sold the company in 2011 and then, with renewed vigour, bought it back in 2012.

“There’s been a lot of damage to fix. But I think the best way to fix it is just to keep on doing a great job,” he says.

In the seven years Planet Hospital has offered surrogacy services, it has helped about 500 gay couples have babies, Rupak says.

But gay surrogacy has a set of challenges all its own. Planet Hospital’s California office was boycotted by the infamous Westboro Baptists after word first got out, Rupak says. And they had to quickly switch gears after India banned surrogacy for gay men, swapping their primary operation focus to Mexico.

Each surrogate in Mexico gets a flat rate of $12,000 U.S., plus room and board.

Rupak readily admits that’s not even half of what a surrogate gets paid in the U.S.

“I’ve heard words like ‘exploitation’ used to describe $12,000, so I want to put that in perspective,” he says. He then explains that a cashier in Mexico makes less than a quarter of what a cashier earns in the United States.

“We’re not paying a quarter of what a surrogate makes in America. We’re paying a half what a surrogate makes. I don’t think that’s exploitation,” he says.

But Ellen Embury, a fertility lawyer in Calgary, says the situation sets off alarm bells for her. First, it worries her that the company is allegedly telling Canadians such as Sam – the 24-year-old from Edmonton - that surrogacy at home costs more than it really does. It really shouldn’t cost more than $60,000 in Canada, she says.

Sam says Rupak and the company’s vice-president, Geoff Moss, told him that surrogacy in Canada would cost him “almost triple” compared to the $42,000 U.S. it would cost him in Mexico.

On several occasions while explaining surrogacy to the Herald, Rupak says that surrogacy in Canada costs about $100,000.

If the cost is the biggest barrier for someone who hasn’t done extensive research and doesn’t know any better, then they’re going outside Canada and taking unnecessary potential risks, Embury says.

And she, too, says she’s worried about the possibility of surrogate exploitation.

***

A large saucepan of Rajas – a mouth-watering stew of hot peppers, tomatoes, onions and cheese – simmers on the stove in the Cancun surrogacy house, filling the air with its thick scent.

This, along with heaping servings of rice, will be the mid-day meal for the nine women currently living in the house, although it can fit as many as 15 surrogates at a time. Later, the women will be escorted on a 6-km walk down the palm tree-lined promenade near the city’s hotel zone.

The meal, the walk, the bedtime and the estrogen patches stuck across the abdomens of most of the women are all part of a carefully controlled program.

To be a surrogate with Planet Hospital, a woman has to be between the ages of 18 and 40, and has to be a single mother. She has to pass extensive medical and psychological testing. And she has to agree to follow the program set out by Planet Hospital.

“They have to be willing to do what I say, by which I mean medical-wise, eating well, and taking care of themselves,” Garibay says.

The women move into the house about a month before their scheduled embryo transfer. Garibay stresses that the women have a choice – they don’t have to live in the house – but it’s strongly encouraged. Most of the surrogates aren’t from Cancun.

Although the women are welcome to bring their children with them to Cancun, in July only Karina – who asked that her last name not be printed – has her two-year-old son there.

The house has a sunny backyard with a small, kidney-shaped pool. There are four bedrooms for the surrogates, each of them filled with at least threetwin beds, all covered in the same flowered sheets.

The women come from a variety of backgrounds, Garibay says. Many were in abusive relationships before they became single parents. Most of them had jobs but they all need the extra money to support their children.

Lizbeth, 26, was a student. Karina, 35, was a department store manager. Adriana Rincon, 32 – who is pregnant with the child of a Calgary gay couple – was a social worker. Alejandra Perez, 40, was a cook. Nancy, who did not give her age or last name, worked as a maid and has a disabled daughter.

Miriam Galicia, the former police officer, grins broadly, revealing a few missing teeth, and says the surrogate house is far nicer than her house in Toluca.

“We don’t have a pool. I can go to the beach here,” she says through an interpreter.

Galicia has three children, aged 16, 14 and two. They’re in Toluca.

She and her husband divorced nine years ago, and she has struggled to support her family.

A few years ago she was accepted as a surrogate in Mexicali, where Rupak says he was testing out how the surrogacy process would work in the country. They had five cases, Rupak says, and three got pregnant – including Galicia.

She gave birth to twins two years ago. Galicia used the money to help put her daughter through high school and to support her family.

But the bills piled up again. She contacted Planet Hospital and now she’s living in the surrogate house and has agreed to carry an HIV-positive couple’s embryo for a $6,000 bonus.

The transfer was scheduled for August. She lifts her shirt to show the estrogen patches on her abdomen, not shy about revealing the folds of loose, wrinkled skin etched with stretch marks. These are the battle scars from carrying twins.

She’ll use the money from this pregnancy to put her son through school, she says, and then she hopes to buy a piece of land and build a proper house for her family.

“I cannot help the world with anything but I can help a family. I wanted to help just a little bit to make someone happy,” she says.

***

The most basic Mexico package includes $5,000 to an anonymous egg donor living in the Cancun region, $12,000 to the surrogate, and about $8,000 for IVF (which includes a second attempt if the first doesn’t take).

The rest goes toward surrogate accommodation, meals and medications; testing, donor and surrogate recruitment, and lab and clinic fees. The total is usually around $42,000 U.S.

It will cost an additional $15,000 if the intended parent who’s donating the sperm has HIV – of this, the surrogate will get a $6,000 bonus. In this case, the semen donor has to fly to a fertility clinic in Los Angeles and make his deposit there, where it will be tested and washed according to FDA standards, says Planet Hospital’s Moss.

But it’s the bonus that Dr. Mathias Gysler, the head of the Canadian Fertility and Andrology Society, says makes him nervous.

Handled properly, the risk of transmission to the surrogate or the fetus should be extremely small – “most likely approaching zero,” he says.

“Why would you pay someone extra money for taking on a risk if there’s supposed to be no risk,” he says.

Moss explains that, even though there’s no real risk to the surrogate, the extra $6,000 does help act as “extra incentive.”

“The extra compensation goes to the surrogate for carrying a child that does, theoretically, have some type of risk even though it’s like .000001,” he says.

Even with the low risk, there would have to be a “very, very special set of circumstances” for a Canadian fertility clinic to implant an embryo from an HIV-positive donor into a surrogate, Gysler says.

“It wouldn’t on the surface be something I would do,” he says.

For another bonus, if the would-be parents want to increase their chances, they can hire two surrogates and implant embryos in both – something Gysler says he’s never seen in Canada.

Both women would be paid $12,000 if the pregnancies are full term, plus a bonus if they wind up carrying multiples.

Abortion isn’t out of the question if the parents wind up with more fetuses than they bargained for.

Mexico has very strict abortion rules, Rupak says, but it is allowed in some places.

According to the fact sheet Planet Hospital sends to intended parents: “Abortion is technically illegal in Mexico however it can be performed in Mexico City.

“On the record, I just say that we will do whatever is compliant with Mexican law,” Rupak says.

The surrogates are strongly encouraged to give birth by a scheduled C-Section. In a Planet Hospital fact sheet distributed to intended parents, one of the questions is “How do we know when to be in Mexico to pick up the baby?”

“All our births are performed by C-section so we can tell you exactly when to be there. If you would prefer a traditional birth please advise us in advance,” the sheet says.

But Rupak stresses that Planet Hospital would never force a surrogate to give birth by C-section – it’s her choice, he says.

***

Javier Iniesta walks into the waiting room of Fertility Center Cancun with a Band-Aid in the crook of his elbow.

He’s just given his blood and his semen so that he and his partner, Edward Venema, can start making their family. The couple flew from Murcia, Spain, and they desperately want a child.

“We’re just looking forward to seeing him or her grow up, and starting to run through the house chasing the cats,” Venema says, his eyes glowing, as Iniesta, 39 and a nurse, tilts his head down and laughs.

Another international couple in Cancun – the Chomkos of New York City – say they discussed having children on their first date. They knew they wanted a genetic tie to their child and had researched their options for a long time. They were married in July and booked a honeymoon in Cancun.

When they realized they would be staying near the Planet Hospital Partner Clinic, they booked an appointment to meet with Garibay and learn more.

“It’s coincidental that we’re here, but it just kind of worked out that way,” 31-year-old Rich, a teacher, says.

They have some trepidation about international surrogacy, especially regarding the possibility of exploitation, but might make a semen donation at the clinic if they like what they see at the surrogacy house, Thomas says.

After meeting some of the surrogates in the house a few kilometres from the clinic, the Chomkos ask to speak with Garibay alone.

Back in Edmonton, Sam says that after all his research he’s thrilled to get the ball rolling. With his deposit made, now he and his husband just wait: for the transfer, for the news that they’re pregnant, and then for the phone call advising them of a date for the birth.

“We’ve been waiting for so long, and looking for so long, but this is what makes it all worth it, thinking about how much better it will be holding the baby on the final day,” he says.

“Basically now it’s all in the hands of nature and God.”

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